MEDICARE: JACQUELINE C. FIELDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33698	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE C. FIELDS M.D.

Provider Business Mailing Address
First Line	:	315 CANYON AVE
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2677
Country	:	US
Telephone Number	:	970-472-6789
Fax Number	:	970-472-6799

Provider Business Practice Location Address
First Line	:	315 CANYON AVE
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2677
Country	:	US
Telephone Number	:	970-472-6789
Fax Number	:	970-472-6799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/02/2013

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